Britain’s N.H.S. in Crisis: ‘We Might Break’

Jan. 16, 2018

LONDON — Britain’s National Health Service, put in place by the country’s post-World War II Labour government, holds a unique place in the country’s psyche as both source of constant frustration, object of affection and — somehow — a central pillar of arguments both to leave and remain in the European Union. In a country riven over Brexit, at least most people can agree on the importance of the N.H.S.

What its future should be is less clear.

The N.H.S. suffered from staff shortages and tight budgets long before Brexit, but in the year following the referendum almost 10,000 nurses quit. In November, Simon Stevens, the chief executive of the service in England, said that after seven years of budget constraints “the N.H.S. can no longer do everything that is being asked of it.”

Amid a flu outbreak, colder weather and the continuing shortages of beds and staff this winter, some hospitals declared “black alerts,” meaning they were unable to deliver comprehensive care. Nonurgent surgeries were postponed and patients waited more than 12 hours in emergency wards before being tended to — undergraduate medical students were reportedly asked to volunteer to ease some of the strain.

In interviews over the last few months, we asked N.H.S. staff to describe what it’s like to work for the service now, and what they hope and fear for its future.

According to the staff we spoke to, the N.H.S. has come to a decisive moment: Is there still the political will and public support for universal health care in Britain? Or is a privatized system, similar to the United States, its future?

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Francesca Silman is a general practitioner in East London.CreditTom Jamieson for The New York Times

People aren’t getting the care they need

“Even until very recently, very few people opted out of the N.H.S. It was considered completely for everybody, really good quality, service and something that people could actually trust; you knew if you went through the N.H.S. system, you would get safe, good health care.

I think that’s starting to change, and people are starting to worry about whether that’s still the case.

Time and time again people said they voted for Brexit because they thought it would give more money to the N.H.S. and that was very quickly retracted from the Brexit campaigners the minute Brexit came through.

People are very, very angry that they felt that they were voting for more money for their National Health Service, and that’s not been happening.” — Francesca Silman

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Ben White is a doctor and N.H.S. campaigner.CreditTom Jamieson for The New York Times

I want to fight to keep it

“I think it’s the best health care system in the world. And I want to fight to keep it that way. I think we should be spending more, in order to keep it equitable and make sure that everyone can get — make sure that everyone has freedom from fear, essentially. Because that’s what illness is. That’s what sickness and illness is. And if you don’t have insurance in America, you live in fear every single day for your life, for your family’s life, and that’s not a situation we ever want to get into. Anything that is a road to that situation I think we have to stop.

When you’ve had that idea that actually you can see the direction of travel, and it might not be there in the future, if things continue in the same way, that is absolutely terrifying.” — Ben White

Joan Pons Laplana is a nurse in Norfolk, England.CreditTom Jamieson for The New York Times

If I was younger, I would have left

“More and more European nurses, more and more European doctors are leaving. And we don’t have new recruits coming. That’s what’s happening at the moment. And for example, one thing to happen in my hospital is that our numbers of nurses have declined, and we had one choice: We had to decide to put more patients for each nurse or to shut one ward. At the moment, we have decided to not compromise the quality and we have closed one ward.

If I was 10 years younger, I probably would have packed and left. Not because the hospital itself is not supporting me, it’s because it’s what the government is doing with the conditions, and the way that they make us feel unwelcome, and the uncertainty. It’s been nearly 550 days from Brexit, and I still don’t know what my rights look like.” — Joan Pons Laplana

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Vikas Tripurneni is an anesthesiologist in East London.CreditTom Jamieson for The New York Times

This is not an affordability question

“I know of nurses who are on food banks. I know of nurses who can’t afford a house in London and stay in their car. And that’s wrong. These are hard-working people, who are putting everything that they can to serve and do something useful. They are working people and they shouldn’t be in a state where they cannot afford basic needs of life.

This is what my worry is. The whole N.H.S. is being made to deliberately fail. So that private entities can be put in to place. Fifteen years back, I can’t think of something private in the N.H.S. except maybe a coffee shop in the front. Now, parking is managed privately, cleaning is managed privately, kitchens are managed privately, hospital and estates and everything else are privately managed.” — Vikas Tripurneni

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Nadia Masood is an anesthesiologist in West London.CreditTom Jamieson for The New York Times

The N.H.S. is a thing that a lot of people aren’t going to appreciate until it’s gone

“After the Brexit vote, a lot of workers feel unwelcome.

They come here because they really admire the N.H.S. They’re slogging their guts out and they don’t even feel welcome.

We’ve reached the point where we’re not able to give more any more. People cannot give any more, and that’s what we’re starting to see.

I’ve never known anything other than the N.H.S., so for me the concept of becoming a doctor was never about money. I don’t know what it’s like in other countries, but here you don’t do it for the money, it’s a public service.

When you have grown up here and you’ve never known anything but the N.H.S., it’s easy to take it for granted. It never entered my mind that if I lived anywhere else, it wouldn’t be like this.” — Nadia Masood

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Michaela Scheuermann-Freestone is a consultant cardiologist in Hampshire, England.CreditTom Jamieson for The New York Times

We might break

“If we see a significant decline in nursing staff, in doctors, there’s no way we’re going to keep offering the services that we are at the moment.

We’re already working up to our eyeballs. I don’t think we can.

Personally, I do not have a British passport. I’ve got a German passport. I’m married to a British man, so of course I could easily get a British passport, but I thought it was never necessary. So when Brexit came about, the referendum and then all the talks, it made me physically sick.” — Michaela Scheuermann-Freestone

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Mita Dhullipala is a medical student at Glasgow University, in Scotland.CreditTom Jamieson for The New York Times

We don’t look at where people come from

“I mean, we provide care to people without looking at where they come from, and I think that’s something we need to preserve. And it’s sad to see that many people think that that might not be the case in a few years.

I think there are a lot of students who are reconsidering their future in medicine. Or thinking about alternative careers, or where they can go that’s not directly linked with clinical work. Because it just seems so, so pressured.” — Mita Dhullipala